Health Care

Weeks after key deadline, children’s health care program remains unfunded

Medicaid by the numbers, stethoscope

WASHINGTON — Almost two weeks after a federal health care initiative for children passed a key deadline, lawmakers have yet to move forward to continue the program.

The Children’s Health Insurance Program, or CHIP, expired Sept. 30 — meaning that the federal government is no longer providing new funds to states to administer the program that serves more than 8 million children nationwide.

Most states have enough money in their coffers to continue running the program through the end of the year, according to a report by the Kaiser Family Foundation.

Vermont fiscal experts expect to have enough federal funding to keep going through March, making it, according to Kaiser, one of 32 states that will run out of CHIP money by the end of the first quarter of 2018.

CHIP funds in Vermont support the Dr. Dynasaur program, which is also funded through Medicaid. State officials say if the program is not renewed in Congress, the state will be left with a $22 million hole in its budget.

However, for almost a dozen states, the timeline is more urgent. Eleven will exhaust their reserve funds by the end of December, some within weeks, according to estimates.

The gridlock over CHIP is significant not just for the potential impact of starving states of federal funds to support the program — it also marks a contrast from previous years when the popular initiative has generally been renewed with broad bipartisan support.

“This is without precedent that we’ve gotten to this point,” Jesse Cross-Call, a senior analyst at the nonpartisan Center on Budget and Policy Priorities, said Thursday.

The program was created in 1997 through the bipartisan efforts of Sens. Ted Kennedy, D-Mass., and Orrin Hatch, R-Utah.

In past years, there has been some back-and-forth between different parties about aspects of CHIP, he said. But for two decades, the program has always been renewed by the expiration deadline.

However, this year the Sept. 30 expiration deadline came and went without action on CHIP amid renewed push by Senate Republicans to pass their party’s signature promise — a repeal of the Affordable Care Act.

The proposal to overhaul the health care system brought forward by Sens. Bill Cassidy and Lindsey Graham in mid-September distracted from work that was being done on reauthorizing the children’s health care initiative early in the month, according to Cross-Call.

“They lost basically three weeks of time,” Cross-Call said. “If not for Graham-Cassidy they probably would have reauthorized CHIP by now.”

Since the end of September, committees in both the House and Senate have spent time with legislation — but there is still a ways to go before either measure passes.

“There is a bipartisan agreement and consensus about what CHIP should look like for the next five years,” Cross-Call said. “But moving Congress to act on this is proving more difficult than we’d anticipate.”

The Senate Finance Committee cleared a compromise bill with bipartisan support that would authorize the program continuing an Obama-era bump in the match rate for two years before gradually stepping it down to the rate before the Affordable Care Act. The legislation, however, does not include any way to pay for the program.

The House Energy and Commerce Committee also passed a CHIP extension bill similar to the Senate, but all 23 Democrats on the committee, including Vermont’s Rep. Peter Welch, voted against it.

Though both Republicans and Democrats were supportive of the policies concerning the five-year extension of CHIP, Democrats refused to vote for the bill because of how the program would be funded.

The legislation would establish means testing for Medicare, so people who make more than $500,000 annually would be required to pay for their premiums. Democrats also objected to the level of funding provided for Puerto Rico’s Medicaid program, arguing that $1 billion is too low to meet the territory’s needs, especially after Hurricane Maria.

This week, the Republican chair of the committee, Greg Walden, R-Ore., announced that he would reopen discussion of the bill this week to attempt to reach a deal that Democrats would back. He said the House would proceed with the committee’s original bill if no compromise is reached by the end of the week.

As of Thursday afternoon, no deal had yet been announced in the House committee. With the Senate on recess for the week and negotiations ongoing in the House, CHIP extension is poised to wait until later this month.

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Elizabeth Hewitt

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